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http://pdfs.journals.lww.com/jcraniofacialsurgery/1995/05000/Crouzon_s_Disease_Correlates_with_Low_Fibroblastic.12.pdf
Reports have demonstrated that Crouzon's disease is associated with a gene on chromosome 10 coding for the fibroblastic growth factor (FGF) receptor 2. The purpose of this investigation was to evaluate the FGF receptor 2 levels in cranial sutures of children with Crouzon's disease and nonsyndromic, isolated craniosynostosis. Twelve children between the ages of 6 and 24 months were studied. Four patients had Crouzon's disease with coronal suture stenosis. The 8 remaining had a nonsyndromic, isolated coronal stenosis. Stenosed and adjacent nonstenosed cranial sutures were removed at cranioplasty and promptly fixed, decalcified, and embedded in paraffin. Immunohistochemical analysis of cranial sutures was performed with labeled, specific anti-FGF receptor 2 antibodies. In children with Crouzon's disease, we found significantly lower levels of FGF receptor 2 staining in stenosed sutures compared with nonstenosed sutures. In addition, sutures from children with Crouzon's disease demonstrated lower levels of FGF receptor 2 activity in both stenosed and nonstenosed sutures compared with children with a nonsyndromic, isolated coronal stenosis. However, there were no significant differences in FGF receptor 2 staining between stenosed and nonstenosed sutures in children with a nonsyndromic, isolated coronal stenosis. These findings suggest that low FGF receptor 2 activity in cranial sutures correlates with Crouzon's disease. This work supports genetic studies and yet shows that patients with Crouzon's disease have low FGF receptor 2 activity in cranial sutures. The findings also suggest that there may be etiological differences between syndrome- and nonsyndrome-associated craniosynostoses in children.
(C) 1995 Mutaz B. Habal, MD]]>Thu, 01 Oct 2009 10:39:14 GMT-05:0000001665-199505000-00012http://pdfs.journals.lww.com/jcraniofacialsurgery/1996/01000/An_Increase_in_Infant_Cranial_Deformity_with.5.pdf
No abstract available]]>Thu, 01 Oct 2009 10:40:15 GMT-05:0000001665-199601000-00005http://pdfs.journals.lww.com/jcraniofacialsurgery/1997/05000/Management_of_Severe_Maxillary_Deficiency_in.8.pdf
We present our technique for maxillary distraction osteogenesis in patients with severe maxillary hypoplasia. With the use of an external, adjustable, rigid distraction device, we can now treat patients with severe maxillary hypoplasia with a precise and controlled distraction process, obtaining predictable results. This technique has allowed us to treat patients in all age groups. In this report we review our indications for maxillary distraction and describe our technique using an external, adjustable, rigid midface distraction device.
(C) 1997 Mutaz B. Habal, MD]]>Thu, 01 Oct 2009 10:41:09 GMT-05:0000001665-199705000-00008http://pdfs.journals.lww.com/jcraniofacialsurgery/1998/01000/Use_of_Scanning_Electron_Microscopy_in_the.7.pdf
The cause of craniosynostosis continues to elude researchers. Although several studies have looked at the ultrastructure of normal suture closure, no previous studies have examined the microarchitecture of the synostotic suture. Our goal was to assess the scanning electron microscope (SEM) as a viable and useful tool in examining craniosynostosis. Our hypothesis is that the SEM is a powerful analytical tool that can evaluate nonsynostotic, partial synostotic, and complete synostotic cranial sutures. We analyzed the cranial suture of 3 human infants with nonsyndromic sagittal craniosynostosis. The specimens were separated into three groups, which included regions of partial and complete synostosis and a region of open suture. Histological examination provided cellular and tissue data about craniosynostosis, whereas the SEM provided detailed information regarding the trabecular microarchitecture of the synostosed suture. The SEM produced quality images of complete and partially synostotic sutures and open sutures. At low magnification, the SEM characterized the general bony microarchitecture of cranial sutures in a manner different from, but complementary to, standard histological sections. At higher magnification, the SEM allowed us a look at the cellular population of craniosynostotic sutures in a way that surpasses standard light microscopy. The SEM is an excellent tool for the study of craniosynostosis and has proved invaluable in our ability to evaluate the microarchitecture and cellular population of the fusing suture. We believe we have proven our hypothesis by demonstrating the SEM to be a powerful analytical tool that can evaluate nonsynostotic, partial synostotic, and complete synostotic cranial sutures.
(C) 1998 Mutaz B. Habal, MD]]>Thu, 01 Oct 2009 10:41:45 GMT-05:0000001665-199801000-00007http://pdfs.journals.lww.com/jcraniofacialsurgery/1999/09000/The_Sliding_Sulcus_Procedure__Simultaneous_Repair.7.pdf
During embryogenesis the clefting event unleashes a series of processes that act in concert to deform the soft tissue envelope into a "dysfunctional matrix" within which bone and cartilage subsequently form. Much of secondary cleft deformity results from failure to solve this pathologic soft tissue-bone equation at the primary repair. The sliding sulcus procedure uses the subperiosteal plane to create a centralization of the soft tissue matrix, alleviate tension, and redistribute the forces of growth in a more normal pattern. By incising at the level of the alveolus, this approach preserves the blood supply to the osteogenic cells of the buccolabial periosteum. This approach has interesting theoretical implications for the preservation of alveolar growth potential. Arch stabilization and elimination of fistula may be of long-term benefit to the orthodontist.
(C) 1999 Mutaz B. Habal, MD]]>Thu, 01 Oct 2009 10:51:37 GMT-05:0000001665-199909000-00007http://pdfs.journals.lww.com/jcraniofacialsurgery/2000/11030/A_Resorbable_and_Rapid_Method_for.5.pdf
: Maxillomandibular immobilization in pediatric mandible fractures is accomplished through a resorbable screw placed into the zygomatic body to which is attached a large, monofilament, circummandibular suture. Although the screw must be placed intraoperatively, this method of jaw immobilization is rapid, secure, does not damage the teeth, and can be removed in the office in the older child.
(C) 2000 Mutaz B. Habal, MD]]>Thu, 01 Oct 2009 10:52:32 GMT-05:0000001665-200011030-00005http://journals.lww.com/jcraniofacialsurgery/Fulltext/2001/11000/Surface_Anatomy_of_the_Face_in_Down_s_Syndrome_.3.aspx
The objective of the study was to identify the proportions closest to normal and those indicating mild-to-moderate and severe degrees of disproportion. Eight proportion indices were analyzed in five craniofacial regions of 125 Down's syndrome patients, based on a total of 985 data points. More than two thirds of the patients fell within the normal range, although more than one quarter were abnormal (disproportionate). All statistical summaries were based on z-scores (adjusting for age and sex differences), converted into descriptive anthropometric categories to yield a simplified frequency distribution for each proportion index. Normal proportions were harmonious in 55.9% of patients. Disproportions were mild to moderate in 66.4%, severe in 33.6%. The highest frequency of harmony was found in the head (70.2%), the lowest in the orbits (40.8%). The highest percentage of mild-moderate disproportion was found in the face (79.3%). The highest percentage of severe disproportions was recorded in the intercanthal index of the orbits (44.7%) and the smallest frequency in the face (20.7%). In the five craniofacial regions among the normal proportions, harmonies were more frequent than disharmonies. Among the disproportions, the percentage of mild-moderate ones was greater than those of severe degree.]]>Thu, 01 Oct 2009 10:53:21 GMT-05:0000001665-200111000-00003http://journals.lww.com/jcraniofacialsurgery/Fulltext/2002/07000/Immediate_Cranial_Vault_Reconstruction_With.21.aspx
No abstract available]]>Thu, 01 Oct 2009 10:54:19 GMT-05:0000001665-200207000-00021http://journals.lww.com/jcraniofacialsurgery/Fulltext/2003/07000/Cartilage_Sparing_Complete_Otoplasty_Technique__A.24.aspx
Otoplasty is one of the most frequently performed esthetic surgical procedures in children and adolescents. Several techniques can give satisfactory results, but few address all the components of the prominent ear deformity. The author reports on the evolution and application of a cartilage-sparing otoplasty technique that addresses all the components of the prominent ear deformity. One hundred patients (200 ears) were treated over a 10-year period. An 8% revision rate and minimal complications were encountered.]]>Thu, 01 Oct 2009 10:55:04 GMT-05:0000001665-200307000-00024http://journals.lww.com/jcraniofacialsurgery/Fulltext/2004/03000/Interstitial_Growth_of_Bone_Revisited.26.aspx
The distance between two or more metallic implants placed within the same flat bones (mandible, nasal, frontal, hyoplastron, hypoplastron) of young pigs, rabbits, and turtles followed by means of serial radiographs, remained the same for periods as long as 546 days. Thus, it is concluded that there is no interstitial growth. In 1743, Duhamel demonstrated that long bones grow at their ends and that there is no interstitial growth. This report is unique in that it demonstrates by use of radiopaque implants and serial radiographs that there is no interstitial growth of flat bones, which grow by apposition and resorption, and not endochondrally, such as occurs in long bones.]]>Thu, 01 Oct 2009 10:56:00 GMT-05:0000001665-200403000-00026http://journals.lww.com/jcraniofacialsurgery/Fulltext/2005/09000/Producing_Accurate_Platelet_Counts_for_Platelet.4.aspx
Platelet rich plasma (PRP) has been shown to clinically accelerate healing of both soft and hard tissues. As a result, it has gained increasing popularity. However, the clinical effectiveness of each type of PRP preparation method can vary in technique and efficiency, and current methods to evaluate the platelet concentration efficiency of PRP systems have several limitations. Therefore, the purpose of this study was to validate an automated hematology analyzer, the Cell-Dyn 3700, to accurately count platelets in concentration ranges of approximately 2,000,000-4,800,000 platelets/μL. PRP platelets were counted by way of a manual counting method and on the Cell-Dyn 3700, and the statistical evaluation indicated no difference between the groups (P > 0.05). Dilution of the PRP was not required, and accurate platelet counts could be achieved up to platelet concentrations of 4,800,000 platelets/μL. PRPs must be resuspended on a rocker for at least 5 minutes before platelet counts, and the entire PRP sample must be resuspended to allow for equal distribution of platelets before counting. With use of the validated Cell-Dyn 3700, a platelet concentrate system was used to prepare 153 PRPs. The baseline whole blood platelet concentration (328,000 platelets/μL ± 69,000 platelets/μL) and the average PRP samples (2,645,000 platelets/μL ± 680,000 platelets/μL) were compared, resulting in an eightfold increase in concentration and an average platelet percent recovery of approximately 76%. Automated hematology analyzers can be used to accurately count platelets in PRP given the system has been validated appropriately and the PRP samples are prepared properly to provide adequate platelet suspension.]]>Thu, 01 Oct 2009 10:57:13 GMT-05:0000001665-200509000-00004http://journals.lww.com/jcraniofacialsurgery/Fulltext/2006/07000/Sturge_Weber_Syndrome_and_Associated_Congenital.24.aspx
Sturge-Weber syndrome (SWS), Klippel-Trenaunay syndrome (KTS), and Parkes-Weber syndrome (PWS) represent a wide range of congenital vascular abnormality syndromes. Although many of the diagnostic criteria overlap for these syndromes, there are important differences among these diseases that carry important prognostic and therapeutic implications. This review attempts to clearly distinguish among SWS, KTS, and PWS, although loosely categorizing them as a family of congenital vascular disorders. A review of literature reveals that a variety of diagnostic tools exist that can help differentiate between the syndromes and assess risk for certain complications, which may help tailor various treatment modalities for a particular patient.]]>Thu, 01 Oct 2009 10:58:24 GMT-05:0000001665-200607000-00024http://journals.lww.com/jcraniofacialsurgery/Fulltext/2007/05000/Strabismus_in_Unicoronal_Synostosis__Ipsilateral.2.aspx
Unicoronal synostosis is a premature fusion of one of the coronal sutures and is thought to carry an increased prevalence for strabismus. Studies suggest the nature of the strabismus to be a hypertropia occurring ipsilateral to the fused coronal suture. The aim of this study is to investigate the laterality of strabismus in unicoronal synostosis and report on ocular motility and refractive findings in a large, unbiased sample group. A retrospective case study analysis was carried out on 59 patients with a confirmed diagnosis of unicoronal synostosis referred to the Oxford Craniofacial Unit over a 14 year period. Manifest strabismus in the primary position was found in 34 (57.6%) cases. In 19 (55.9%) cases, this occurred contralateral to the fused suture, and in 9 (26.5%) cases, strabismus was on the ipsilateral side. Six had alternating strabismus. These results are contrary with apparent findings in the literature but are not statistically significant (P = 0.0872) for strabismus occurring more frequently on the nonsynostotic side. Esotropia with a vertical component was most common, found in 61% of all cases with strabismus. Apparent inferior oblique overaction was found in 30 of the 59 (50.8%) cases, with this occurring bilaterally in 14 cases. Significant refractive error was found in 46% of all cases, most of which showed anisometropia and astigmatism that occurred more frequently on the contralateral, nonsynostotic side (P = 0.0106). All cases of unicoronal synostosis with a mutation of the FGFR2 or FGFR3 gene had manifest strabismus. Manifest strabismus was found in 57.6% of cases reviewed, but this was found to be no more likely to occur on the side contralateral or ipsilateral to the fused suture (P = 0.0872). Anisometropia and astigmatism were found more frequently in the eye contralateral to the fused suture.]]>Thu, 01 Oct 2009 10:59:34 GMT-05:0000001665-200705000-00002http://journals.lww.com/jcraniofacialsurgery/Fulltext/2008/03000/Reflections_at_34000_Feet.2.aspx
No abstract available]]>Thu, 01 Oct 2009 11:09:45 GMT-05:0000001665-200803000-00002http://journals.lww.com/jcraniofacialsurgery/Fulltext/2009/01000/Soccer_Related_Facial_Fractures__Postoperative.7.aspx
Facial fractures are one of the most common orofacial injury sustained during participation in sporting events.
The frequency of maxillofacial lesions varies according to the popularity that each sport has in a particular country. Soccer is the most popular sport in Italy, and it is responsible for a large number of facial traumas.
Traumas and fractures in soccer mainly involve the zygomatic and nasal regions and are especially caused by direct contact that takes place mainly when the ball is played with the forehead. In particular, elbow-head and head-head impacts are the most frequent dangerous contacts.
Soccer is not a violent sport, and the use of protective helmets is not allowed because it could be dangerous especially when players play the ball with the head. The use of protective facial shields are exclusively permitted to preserve players who underwent surgery for facial fractures.
The use of a facial protection mask after a facial fracture treatment has already been reported. This article describes a clinical experience of management of 4 soccer-related facial fractures by means of fabrication of individual facial protective shields.]]>Fri, 05 Nov 2010 16:10:54 GMT-05:0000001665-200901000-00007http://journals.lww.com/jcraniofacialsurgery/Fulltext/2010/01000/Papilledema_in_Isolated_Single_Suture.4.aspx
The purpose of this retrospective study was to assess the prevalence of papilledema in patients with isolated craniosynostosis. Second, we wanted to assess if the presence of ventricular dilatation on computed tomography (CT) scan is a predictive factor for the occurrence of papilledema.
We included 205 consecutive children with an isolated single-suture craniosynostosis, who had at least 1 fundus examination. Preoperative CT scans of the brain were examined for the presence of ventricular dilatation.
Papilledema developed in 14 of 205 patients: 10 developed papilledema before surgery and 4 during the follow-up period. Ten of the patients with papilledema had a synostosis of the sagittal suture, and 4 of the metopic suture. Prevalence of papilledema in scaphocephaly was 9.7%, and in trigonocephaly, 5.6%. Based on evaluation of all CT scans, ventricular dilatation seemed not to be a predictive factor for papilledema in children with isolated craniosynostosis.
The incidence of papilledema in almost 10% of scaphocephaly patients is remarkably higher than expected. Therefore, we recommend routine preoperative screening, especially for patients with scaphocephaly, but also for patients with trigonocephaly. Postoperative screening is recommended in all patients when there is any uncertainty.]]>Wed, 07 Mar 2012 10:45:23 GMT-06:0000001665-201001000-00004http://journals.lww.com/jcraniofacialsurgery/Fulltext/2011/01000/Deformational_Plagiocephaly__A_Look_Into_the.2.aspx
No abstract available]]>Thu, 14 Feb 2013 12:51:16 GMT-06:0000001665-201101000-00002http://journals.lww.com/jcraniofacialsurgery/Fulltext/2012/09000/Craniofacial_Principles_in_Face_Transplantation.2.aspx
Background: Face transplantation allows the reconstruction of the previously nonreconstructible injury. Anthropometric landmarks are fixated to corresponding cephalometric landmarks to restore function and appearance, with emphasis on phonation, mastication, and functional upper airway. Currently, only a few face transplantations have been performed worldwide. A portion of these reconstructions involves combinations of hard and soft tissues of the midface.
Methods: Craniofacial and orthognathic considerations should be emphasized for functional effect in the planning and execution of face transplants that include both bone and soft tissue elements. These steps are taken to restore normal anatomy by fixating the midface into proper relationship with the skull base. Traditional orthognathic planning, using cephalometric parameters, often involves a line through sella and nasion as a reference for the skull base. Intraoperatively though, without a cephalograph, the sella-nasion plane is not accessible as a reference point.
Results: Postoperative analysis of our first face transplant recipient revealed that the Frankfort horizontal plane can alternatively serve as an accessible skull base reference point to guide the positioning of the midface. We have developed a technique to ensure fixation of the midface donor allograft in a proper functional relationship with the skull base, within 1 SD of Bolton normative data.
Conclusions: “Reverse craniofacial planning” allows for precise fixation of the hard tissue components of the face transplant in relation to the skull base, as opposed to a “best fit” approach. We believe that this relationship results in the most anatomical restoration of occlusion, speech, and airway function.]]>Tue, 01 Mar 2016 09:28:57 GMT-06:0000001665-201209000-00002http://journals.lww.com/jcraniofacialsurgery/Fulltext/2013/01000/Complex_Scalp,_Skull,_and_Dural_Defect.16.aspx
Background: The latissimus dorsi flap is one of the most commonly used flaps for calvarial defect reconstruction. In the setting of radiation and/or chronic infection and when skeletal reconstruction of the cranium is not recommended, standard calvarial reconstruction needs to be refined. The standard use of the latissimus dorsi only was associated with potential dead space over the dura, limited skin paddle size, and potential external contour irregularities.
Methods: In this study, we present our approach to complex calvarial reconstruction with free tissue transfer without bone grafting while avoiding contour deformities in 1 efficient surgical procedure. We propose the “tournedos” turnover de-epithelialized latissimus dorsi flap, which provides stable dermal and subdermal tissue that will not undergo atrophy over time over the dura. To reach an adequate aesthetic result, we used a uniform, unmeshed, thick split-thickness skin graft over the muscular portion of the tournedos flap. Patients who underwent this procedure, from March 1992 to March 2012, at McGill University Health Center and the Montreal Neurological Institute were included.
Results: Thirty-three complex microsurgical procedures for oncologic calvarial defect reconstructions were performed from March 1992 to March 2012. Among them, 6 patients benefited from the tournedos procedure. The average age was 74 years. Scalp defects sizes ranged from 4 × 10 to 16 × 18 cm (40–288 cm2). All latissimus dorsi flap donor sites were closed primarily. Patients kept their donor-site drains for approximately 18 days (±5 days). One patient developed a seroma at the donor site after drain removal that was treated conservatively. All patients were satisfied with their reconstructions, and no secondary procedures were necessary. We present our most recent case with good photographic documentation.
Conclusions: Our approach using the tournedos turnover de-epithelialized free flap provides durable and stable coverage for irradiated and/or previously infected calvarial defects. It is a safe procedure in those challenging complex cases and offers many advantages.]]>Tue, 01 Mar 2016 09:30:05 GMT-06:0000001665-201301000-00016http://journals.lww.com/jcraniofacialsurgery/Fulltext/2014/01000/Flap_Prefabrication_and_Stem_Cell_Assisted_Tissue.8.aspx
Abstract: Total face skin and soft-tissue defects remain one of the biggest challenges in reconstructive surgery. Reconstruction of the entire face with uniform coverage and delicate features is difficult to achieve. To avoid the patchwork result seen in multiple flaps and skin grafts, 1 monoblock flap that has similar color, texture, and thickness might be an ideal option to minimize the incisional scars and several surgical procedures but is unavailable with current approaches because of the lack of sufficient matched tissue and the unreliable blood supply for such a large flap. To acquire a monoblock flap for full face reconstruction, we combine the prefabricated flaps, skin overexpansion, and bone marrow mononuclear stem cell transplantation for total facial resurfacing. In this article, we present our experience from our case series that provides universally matched skin and near-normal facial contour. It is a reliable and an excellent reconstructive option for massive facial skin defect.]]>Tue, 01 Mar 2016 09:32:32 GMT-06:0000001665-201401000-00008